 San Diego County Optometric Society |
The San Diego ViewJune 2018 |
Inside this Issue:
- President’s Message
- Retina Corner
- Tech Corner
- Eye See
- Shamir Autograph II+®, Tailored for Your Everyday
- Walman Optical
- CE Corner
- Classifieds
- Volunteer Corner
- SDCOS Announcements
- Upcoming Events
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President’s Message
June 2018 |
June marks the beginning of Summer, a time where San Diegans flock to the beautiful beaches around town and enjoy the sunshine and warm weather. Summertime also marks the time of year where Optometry Students graduate their final year school and become full-fledged Optometrists. That may mean starting to practice or continuing on with one of the many Residency Programs around the country. These first few transition months can be difficult for new graduates for a variety of reasons. After completing the toughest examination period of their lives and finishing a goal that they set out on four years prior, the next steps could very well be unknowns. The California Optometric Association and San Diego County Optometric Association can help make those daunting next steps a little easier. Many of us were COA members as students (it’s free for students, which is a huge benefit) but many do not realize that their student membership continues to the end of the year in which you graduate. This most recent group of graduates can take advantage of all the member benefits while they transition into a working professional. The COA provides Resource Guides to help with obtaining state licensing, DEA and NPI numbers, as well as getting credentialed with the various insurance plans in our state. Career resources are also available, such as job search tools and business/career webinars. At the local level, SDCOS offers new graduates a variety of resources and opportunities to find their career path. Dr. John Fitzpatrick maintains our society’s classifieds and job connection list, which is a great tool if you are looking for a job, are looking to hire someone, and for people looking to buy or sell a practice. Please reach out to him (jpfod@aol.com) with any inquiries. The society newsletter and website also provide great information for new graduates or doctors new to San Diego. Despite having these great resources at our fingertips, sometimes the best resource is reaching out to new graduates and new doctors in the area. By showing them the benefits the COA and SDCOS have to offer, it can be extremely impactful and helpful to them while growing our membership and strength as a society. It might also make this chaotic time of year a little more manageable.
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Retina Corner
The Treatment of Diabetic Retinopathy |
By Nikolas J.S. London, MD FACS
Director of Clinical Research, Retina Consultants San Diego
Chief of Ophthalmology, Scripps Memorial Hospital La Jolla
Hey everyone – I hope you are all well. Graduation season in the London household with Jack London finishing preschool and Max finishing first grade. Little Cole just finished his first year of preschool and is a crazy little kid.
So, I wanted to talk about treating diabetic retinopathy this month – specifically non-proliferative retinopathy, and early neovascularization. It is an underdiscussed subject and I think it is interesting. Up until very recently, we have not had any treatment options. It is one of those disease we traditionally observe, and if/when it gets worse we treat. Commonly, treatment is initiated once patients develop vitreous or pre-retinal hemorrhage, and starts with ablative therapy (laser) to the peripheral retina. There are good reasons to start earlier than this, and we can now not only prevent bleeding in the vast majority of cases, but can actually reverse retinopathy in a large proportion of patients, greatly lowering the risk of diabetic complications.
Taking a step back, we all know that diabetes is a major problem in our country, with prevalence over 10% in most of the country and nearly 8 million patients with diabetic retinopathy. Only a 2 million of these are diagnosed and only 1 million are treated. Diabetic retinopathy manifests as microaneurysms which can burst to produce retinal hemorrhages, capillary loss and non-perfusion, venous beading, and macular edema. Progressive ischemia can lead to neovascularization, which can cause vitreous hemorrhage, retinal detachment, and/or neovascular glaucoma. We grade patients on a recently simplified 1-10 scale called the diabetic retinopathy severity scale (DRSS).
Historically, patients only progress to higher levels on the DRSS, but recent data have shown that serial anti-VEGF injections such as ranibizumab and aflibercept can actually lead regression of diabetic retinopathy. In the pivotal ranibizumab trials for diabetic macular edema, RIDE and RISE, monthly injections over 2 years led to a 2-step regression on the DRSS in nearly 40% of patients. Even more impressively, patients starting with severe NPDR demonstrated an 80% 2-step regression on the DRSS. These are the patients at the very highest risk of conversion to proliferative diabetic retinopathy (PDR) – 50% over the course of a year. These are also the patients in whom we see a significant decline in quality of life with the progression of their DR. Certainly this is a good group to target and consider anti-VEGF therapy on.
Patients who do end up with PDR also benefit from anti-VEGF treatment compared to traditional laser photocoagulation. Protocol S of the DRCR network compared ranibizumab to pan-retinal photocoagulation and showed that patients treated with injections fared better on several levels – better final vision, preservation of peripheral vision, lower incidence of vitreous hemorrhage development and need for vitrectomy surgery. Following these results, there has been a substantial shift in practice patterns with many retina surgeons starting with injections first and adding laser as needed. Of course, not everyone is a good injection candidate, particularly those patients who are at a higher risk of loss to followup.
I will be interested to see how this treatment paradigm evolves over the next 5-10 years. It is exciting to be able to reverse disease for patients, and exciting to think about the effect of the more potent medications that are in various stages of development. I hope to never have a patient go blind from diabetes again.
Thanks again for reading. Please don’t hesitate to contact me with any questions.
Best wishes, and until next time,
Nik
Nikolas London, MD
Retina Consultants San Diego, Poway, La Jolla, and Coronado
www.retinaconsultantssd.com
858-451-1911 (office)
415-341-5456 (cell)
nik.london@gmail.com (personal email)
retinaconsultantssd@gmail.com (RCSD email)
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Tech Corner
Got Tech questions? We’ve got Answers! |
IF YOUR PRACTICE HAS A CYBERSECURITY BREACH, WHO IS THE LIKELIEST CULPRIT?
By Dave Tuckman from Golden State Web Solutions, Inc. (www.GSWS.com)
For this month’s piece, I wanted to share an article from the Review of Optometric Business. Backed by the results of Verizon’s 2018 Protected Health Information Data Breach Report, this shows where breaches are most likely to occur, and how healthcare is behind other industries in securing personal information in its databases. Give it a read, and as always feel free to reach with any questions. CLICK HERE FOR ORIGINAL ARTICLE http://reviewob.com/practice-cybersecurity-breach-likeliest-culprit
When cybersecurity breakdowns occur in healthcare, there are usual suspects you can look to, a new report from Verizon suggests.
More troubling, those usual suspects are usually part of the health-care organization where the breach occurred, and healthcare is behind other industries in securing personal information in its databases.
The 2018 Protected Health Information Data Breach Report (PHIDBR) from Verizon, which Clinical Innovation + Technology details on its web site, included the evaluation of 1,368 cybersecurity incidents from 27 countries. It delves into the cybersecurity of healthcare following the Data Breach Investigations Report (DBIR). The PHIDBR includes findings on what cased cybersecurity incidents, what types of incidents are most common, and solutions to improving the privacy and security of patient data.
FINDINGS INCLUDED
- 21 percent of cybersecurity incidents occurred because of stolen laptops that contained unencrypted patient data.
- 70 percent of cybersecurity incidents with malicious code were classified as ransomware attacks.
- 58 percent of cybersecurity incidents in healthcare involved insiders. Insiders were found to endanger data for financial gain (48 percent), fun or curiosity in reading personal records (31 percent) and convenience (10 percent).
- 27 percent of security incidents involved patient health information on paper records. Breaches of patient information from paper records are more prevalent in the healthcare sector. The main causes included sensitive data not being delivered correctly (20 percent), thrown away without shredding (15 percent) and lost paper documents (8 percent).
SOLUTIONS TO IMPROVING CYBERSECURITY INCLUDED
- Full encryption: “These services are effective and low-cost ways of protecting patient data.
- Continuous monitoring of who has access to records: Cybersecurity polices should be required to the monitoring of patient health record access. Training employees and adopting warning banners could reduce incidents causes by internal factors.
- Develop preventative measures: Adopting measures to combat ransomware attacks and malware would prevent devices from being hacked and patient health records from being accessed.
Questions/Thoughts?
Reach out. You can reach Dave directly at (619-905-4468) or dave@GSWS.com.
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Eye See written by Dr. Byron Y. Newman ASSESSING OUR OPTOMETRIC DEVICES |
Whether it involves a technology as simple as a stethoscope or as complicated as an MRI, almost every encounter between a healthcare provider and a patient involves some sort of medical device, according to two medical authors in a special issue of The American Journal of Managed Care.
And, it’s all based on “evidence of need” for insurance companies and other payers, so that health providers can direct expenditures for new technologies to those that have been demonstrated to benefit patients.
According to one professional, traditional types of “evidence” are no longer sufficient to guarantee a favorable coverage decision by insurance.
The early days of optometry had no hi-tech tools, even visual fields were done by hand and written on a sheet. But, now we have printouts verifying almost everything we do, from visual field plotters, A and B scans, corneal mapping, electronic refractors, even our lensometers print out the results, guaranteeing visible results. Now, besides regular photos, we have computers to capture the pictures.
But, most of the armamentaria for optometry are under the purview of refraction, and everything you can add to improve your Rx for glasses or the need for vision therapy “a service that is not covered.” (Although not true in all insurance and managed care programs.)
Workers Compensation is much more liberal than conventional insurance. One difference is that the laws that govern Workers Comp are liberally construed. Workers gave up the right to bring civil suit against their employers in the last century in exchange for “sure and certain” relief from injury and illness.
So as technology develops in optometry in particular, evaluations as to the effectiveness of each piece of equipment must be made to the satisfaction of insurance payers for it to be a covered service.
Check out Dr. Newman’s website, www.thehumorfactory.com!!!
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Shamir Autograph II+®, Tailored for Your Everyday |
Shamir Autograph II® has been a staple premium progressive lens for over 10 years. To ensure that the lens continues to meet the needs of today’s progressive lens wearer, Shamir has updated the design by incorporating new technologies that enhance the wearer’s experience. Introducing… Shamir Autograph II+®!
Shamir Autograph II+® is a back-surfaced, digital Freeform® lens with the same great design as Shamir Autograph II®, providing wide fields of view and a personalized Rx based on a patient’s selected frame, utilizing As-Worn Technology™. Shamir Autograph II+® was designed to provide more comfort both ergonomically and visually. To accomplish this, Shamir Autograph II+® also incorporates two new technologies: Close-Up™ and Natural Posture™.
Close-Up™ technology adjusts the reading zone inset of the lens, allowing for a more comfortable visual experience for both reading and intermediate viewing. The adjustments are made in 0.1 mm steps within a range of 0 to 5 mm, to accommodate an individual’s unique convergence during near viewing.
Natural Posture™ minimizes discomfort and allows for a more natural, ergonomic near viewing posture. This technology controls the location of the near viewing zone as a function of a plus or minus Rx, influencing both posture and head position.
Shamir Autograph II+® is available in variable and fixed 11mm, 13mm, 15mm, and 18mm fitting heights, in a variety of materials and treatments. Practices participating in Shamir’s RCPV® Rewards Program earn 2,250 points for each Shamir Autograph II+® pair dispensed. Shamir Autograph II+® is now available to order through Shamir’s network of partner laboratories.
If you have any questions, or if you would like to request additional information about Shamir Autograph II+®, please contact Shamir’s Admin department at (877) 514-8330.
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Walman Optical |
At Walman Optical, we are focused on what you need to grow your revenue, increase your profits and enhance patient care through partnered training and development. It’s why education and product knowledge is part of our core Walman Advantage. Knowing what’s next has never been more important. The only way to keep up-to-date and remain relevant, profitable and nimble is having a sharp focus on continued improvement. It’s the reason we share what we know and connect you to our experts with seminars, networking opportunities and advice from thought leaders.
Shamir Autograph II+® is available in variable and fixed 11mm, 13mm, 15mm, and 18mm fitting heights, in a variety of materials and treatments. Practices participating in Shamir’s RCPV® Rewards Program earn 2,250 points for each Shamir Autograph II+® pair dispensed. Shamir Autograph II+® is now available to order through Shamir’s network of partner laboratories.
If you have any questions, or if you would like to request additional information about Shamir Autograph II+®, please contact Shamir’s Admin department at (877) 514-8330.
Walman Optical’s commitment to education:
- ECP Advantage, your source for all education events
- Live webinars twice a month
- The Roadmap
- Walman University
- Dispensing Academy
- ABO prep courses
Visit us at www.walmaoptical.com to learn more or call our Optical Help Desk at 877-863-2759.
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CE CornerWe are committed to helping you fulfill your CE requirements through our local meeting with the support of our sponsors! |
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June 10th, 5 Hr – Retina Symposium
Speakers/Topics:
Anne Hanneken– Non-exudative macular degeneration
Atul Jain– Retinal Detachment Surgery
Nikolas London– Diabetic Retinopathy and DME- Secondary IOLs
Arash Mozayan– Exudative macular degeneration- Interesting Cases
Ehsan Mozayan– Retinal Imaging and Referral Timeline
Nikolas London (on behalf of Paul Tornambe) – OCT Angiography
See 2018 CE schedule.
Continuing Education Seminars are at the Handlery Hotel 950 Hotel Circle North, San Diego, 92108.
Two-hour seminar, Thursday, 7:00 pm – 9:00 pm. Buffet meal included and served ½ hour prior to lecture.
- SDCOS Members free, COA/AOA Members $35.00, Non-Members $130.00.
Five-hour seminar, Sunday, 8:00 am – 1:30 pm. Buffet meal included and served ½ hour prior to lecture.
- SDCOS Members $90.00. COA/AOA Members, $90.00 Non-Members $325.00.
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Classifieds |
Practice for sale –long-established practice in La Mesa–time to retire–will work part-time if the buyer wants–owner interested in an immediate sale–price is right–don’t miss this opportunity to own your own practice for very small investment. 619 743-1442 or email drlevy@pacbell.net (6/18)
We have a fill-in O.D. position working Thursday, June 14, 21, 28 from 9-1 and Saturday mornings starting June 2 from 9-1 for an undetermined length of time. It is in Mira Mesa right off the 805. If you are interested in any or all of the times please email Scott at svoc@sbcglobal.net (08/18)
Full-time position available for an Associate Optometrist with a strong medical background. Large group practice includes 3 Optometrists, 3 Ophthalmologists, full-sized optical, and state-of-the-art equipment in a brand new clinic in Downtown Chula Vista. Job duties include medical co-management of ocular pathology patients along with routine eye care. Requirements include prior residency or minimum 1-year experience in a medical eye care setting, current CA Licensure, and Professional Liability Insurance. Basic Spanish language skills preferred. Competitive Salary. If interested please email a cover letter and CV to Olga Ramirez at castillejoseyeinstitute@hotmail.com (08/18)
Turn-Key Optometry Office for Lease in City Heights 3560 Fairmount Avenue, Suite A, San Diego, CA 92105. ±1,150 SF: two exam rooms, large office & open break/office area upstairs, great signage. High-end finishes, 2004 construction, home to a successful practice for past 14 years. Email cchristensen@rosanopartners.com or call (858) 633-1817 for more information. (06/18)
Dr. John Fitzpatrick, the Society Optometrist Relations Liaison, offers a unique service to the San Diego Optometric community. Several lists are kept on file for doctors seeking the following, or any combination: • full-time work • part-time work • fill-in work • purchase a practice • sell a practice • partner in a practice. There is no charge for this service. To put your name on the list, please contact Dr. John Fitzpatrick at jpfod@aol.com
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Volunteer Corner |
Monarch School Screening
Contact Dr. Bob Meisel for more information at rmeisel@netscape.net ; www.monarchschools.org
Flying Samaritan Optometry Clinic – Tecate, Mexico
The SDSU Flying Samaritans are asking for any optometrists that would be willing to volunteer on Saturdays and accompany other volunteers to their optometry clinic in Tecate, Mexico. It is not necessary to be fluent in Spanish, a translator can be provided. The clinic is located about 40 miles southeast of SDSU. Their goal is to provide free eye exams, glasses, and access to other free medical benefits to the underserved communities of Baja California. Please contact Dr. Bob Meisel if you are interested or have any further questions!
Lion’s Optometric Vision Clinic
ATTENTION LOVC VOLUNTEER DOCTORS
FREE 5-hour CE for SDCOS Members (maximum of 2 CE’s per year)
$70 off for Non-Members choice of 2 or 5 HR CE
VOLUNTEER DOCTORS needed for flexible shifts throughout the year. 9-1:00 pm. Monday -Friday 1805 Upas St San Diego, CA 92103. Can’t volunteer at the clinic? See patients in your office. Call 619-298-5273.
DONATE GLASSES
Please bring to a CE meeting or contact the society office at 619-663-8439 for arrangements to pick up.
SDCOS keeps a list of all doctors willing to speak in front of groups about various topics, do home visits for patients, and assist in student mentoring. ODs interested in the Speakers Bureau, Home Visits, Student mentoring, and Low Vision OD’s, please contact the society office at 619-663-8439 or email sdcos@sdcos.org
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SDCOS Announcements |
Welcome New Members
- Rachel Inlow
- Luis Perez-Rivera
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Upcoming Events |
Contact Us
Phone: 619 663 8439
Fax: 800 643 8301
Email: sdcos@sdcos.org
Platinum Sponsors
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Sustaining Sponsors
